Provider Demographics
NPI:1528584919
Name:SHAH, PRIYA RUPESH (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:RUPESH
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 34TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-3832
Mailing Address - Country:US
Mailing Address - Phone:727-399-6890
Mailing Address - Fax:727-399-6858
Practice Address - Street 1:2950 34TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-3832
Practice Address - Country:US
Practice Address - Phone:727-399-6890
Practice Address - Fax:727-399-6858
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN227551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice